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210 Cards in this Set
- Front
- Back
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what is the criteria for defining a person w/ schizophrenia
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they must have 1 positive symptom + 1 or more of either positive, negative, or cognitive
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In schizo, define what would characterize social or occupation dysfunction?
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a person needs to have 1 or more major areas of functioning that is markedly below the level achieved prior to onset.
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When onset of schizo is in childhood, what would be the social/occupational dysfunction
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consists of failure to attain expected level of interpersonal, academic, or occupational achievement
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The diagnostic criteria for schizophrenia is based on what 6 things
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1. symptoms
2. social/occupation dysfunction 3. duration 4. exclude schizoaffective & mood disorder 5. exclude substance & general medical condition 6. determine if there is a relationship with pervasive developmental disorder |
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what is duration of symptoms for schizophrenia?
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there has to be continuous signs of the disturbance that persist for at least 6 months and includes at least 1 month of positive symptoms
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What must be ruled out before making a diagnosis of schizophrenia?
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1. schizoaffective
2. mood disorder |
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What is the relationship btn schizophrenia & pervasive developmental disorder
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If patient has history of autistic or another pervasive disorder, characteristic symptoms of schizophrenia must be present for at least 1 month
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What is the effect on the body of the older antipsychotic drugs?
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They decrease DA levels which leads to parkinson's like movement and some of these movements may become permanent.
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Which part of the brain is thought to be involved in schizophrenia?
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prefrontal cortex and NAc
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A brain disorder characterized by transient but recurrent seizures
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Epilepsy
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T/F: seizures may or may not be associated with impairment or loss of consciousness and abnormal movements or behavior
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True
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synchronous discharge of large neurons in the central nervous system
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Seizure
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A prolonged seizure lasting longer than 30 minutes
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Status Epilepticus
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This type of epilepsy is considered a medical emergency
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Status Epilepticus
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Who Correctly asserted that epilepsy is a natural disease that originates in the brain rather than a curse from the Gods
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Hippocrates
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Also maintained that people with epilepsy did not hold prophetic powers
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Hippocrates
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Incorrectly believed that epilepsy was caused by a surplus of cold phlegm from the brain flowing down into the warm blood of the body
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Hippocrates
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T/F: Galen was the first to formally note that some epileptic seizures are preceded by an 'aura' or specific sensation of which only the patient is aware
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True
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Galen incorrectly believed that some epileptic seizures can originate in the _______ and spread to the ________
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Body brain
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Correctly noted that alcohol can increase the risk of having a seizure
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Alexandros of Tralleis
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Alexandros of Tralleis incorrectly believed that ________ __________would provide an effective cure for epilepsy
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Herbal remedies
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At this period a more scientific approach to the study of epilepsy begins
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Renaissance Period
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Who wrote a Treatis on Epilepsy or the Falling Sickness
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Samuel Auguste Tissot
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Samuel Auguste Tissot suggested a clear differentiation between _________ & _________
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Idiopathic symptomatic
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Realized that some forms of seizures do not involve loss of consciousness
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John Hughings Jackson
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Jackson noted _________ ________ that progeressed to generalized seizure which is sometimes called_______
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Partial seizures Jacksonian march
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Who was the first person to perform the first successful surgery for treating epilepsy
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Victor Horsley
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conclusively demonstrated the presence of fluctuating electrical potentials in the human brain
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Hans Berger
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What is the % of people who get recurrent seizures
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3%
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Who has the highest incidence for epilepsy
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Young children & elderly
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With all seizures, symptoms are dependent on what
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It depends on location & extent of brain areas affected
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Therapeutic approach depends on what
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Type of seizure
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The 3 major types of seizures
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Partial, generalized, unclassified
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The 2 types of partial seizures
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Simple partial & complex partial
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What are the 2 types of generalized seizures
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Nonconvulsive convulsive
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What are the types of simple partial
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Motor, sensory, autonomic, psychic
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What are the types of complex partial
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Non-evolving & evolving
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What are the types of nonconvulsive generalized seizures
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Simple absence, complex absence, atypical absence
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What are 5 types of convulsive generalized seizures
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Myoclonic, atonic, tonic, clonic, & tonic-clonic
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Partial seizures originate in a small group of neurons which constitute the _______ _________
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Seizure focus
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In partial seizures, what does symptomatology depend on
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The location of the seizure focus w/n the brain
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What is the effect of consciousness with simple partial seizures
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Do not impair it
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How long do simple partial seizures last
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Less than 2 minutes
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This type of seizure usually preceded or consist entirely of an aura
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Simple partial
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Define aura
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Symptom or set of symptoms perceptible only to the patient
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What are some things that make up an aura: a. Sudden sense of fear, b. a rising feeling of the abdomen c. specific sensory perceptions (like experience of an odor) not related to the environment d) all of the above
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D) all of the above
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This subtype of seizure causes a change in motor activity
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Motor simple partial
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T/F: sensory simple partial causes changes in how people think, feel, or experience things
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False, that's psychic
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Which of the following seizure subtypes cause perceptual changes in any one of the senses not actually representative of the environment:
a)motor b) sensory c) autonomic d) psychic |
B) sensory
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This simple partial seizure causess sudden changes in systems under autonomic control
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Autonomic
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How is complex partial seizure different from simple partial
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Complex may involve features of simple partial seizures, but do impair consciousness and short term memory
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How long does complex partial seizure last & how does the person feel afterward
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Generally last from 30-120 seconds, but may leave the patient tired and confused for tens of minutes, and may take several hours to fully recover
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Which seizure involves purposeful movements
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Complex partial seizures
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In complex partial, where is the seizure focus
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Usually in temporal or frontal lobe
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Complex partial types may be either ________ or _________
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Evolving, non-evolving
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__________ complex partial seizures are those that progress to generalized seizures & are also called_________
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Evolving, secondarily generalized seizures
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How can one know if a seizure has a seizure focus or not
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From the EEG
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Define generalized seizures
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Seizures that DO NOT begin with a discrete focal point (seizure focus), but rather involve both hemispheres from the outset.
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Which part of the brain is involved in generalized seizures
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Involve both hemishperes from the onset
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Convulsive seizures are ___________ (generalized or partial) seizures and involve ________ or ________ movements
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Generalized, tonic, clonic
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T/F: non-convulsive seizures are associated with changes in muscle movement or tone
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False: they are NOT associated
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These generalized seizures involve an increase in muscle tone
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Tonic movements
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_________ movements are those that involve repetitive alternation between muscle ____________ & relaxation
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Clonic, contraction
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These seizures are aka petit mal seizures
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simple (or typical) absence seizures
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Which seizures are define by brief episodes of staring
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Simple absence
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Duration of simple absence seizure
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10-20 seconds
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These seizures begin and end abruptly
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Simple absence
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In this type of seizure, patients don't usually realize that they have had a seizure
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Simple absence
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In simple absence, what happens during the episode
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Awareness & responsiveness are impaired
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How is complex absence different from simple absence
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Complex shares all the features of simple but also involve changes in mm activity.
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What are the most common forms of movement in complex absence
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1) Blinking of the eyes
2) slight movement of the mouth, as if tasting something 3) rubbing of the hands 4) contraction or relaxation of muscles |
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How long do complex absence seizures last
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More than 10 seconds
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Atypical absence seizures are defined by
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Like other types of absence seizures, they're defined by brief episodes of staring
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How do atypical absence seizures differ from other absence seizures
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1. typically last more than 10 seconds & can be as long as 30 seconds
2. begin & end gradually 3. leave a patient more aware of events during the seizure |
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T/F: Atypical absence seizures very often is associated with motor movements observed during complex absence seizures
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False: it may or may not be associated
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This type of absence seizure is more likely than other absence seizures to be associated with low intelligence & other cognitive impairments and also more likely to be persistent throughout life
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Atypical
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These seizures are brief like jerks of a muscle or a group of muscles
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Myoclonic seizures
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Besides people with epilepsy, who else can experience myoclonic jerks
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It's commonly seen when falling asleep
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2 features of myoclonic seizures
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1) last a second or 2 2) involve mm groups on both sides of the body simultaneously
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Atonic means ________ ________ so in an atonic seizure all mm suddenly _________
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Without tone, relax
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What are 5 features of atonic seizures
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1. last <15 seconds
2. patient usually remains conscious 3. body bruising or head injury is relatively common 4. aka akinetic seizures, falling seizures, &/or drop seizures 5. often last into adulthood |
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What happens during tonic seizures
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Mm tone is greatly increased; the body, arms, or legs make sudden stiffening movements
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What are 4 features of tonic seizures
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1. duration generally <20 seconds
2. consciousness usually preserved 3. most often occur during sleep & involves most or all of the brain 4. if it occurs while a person is standing, the person will most often fall |
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What happens during clonic seizures
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Consist of rhythmic jerking movements of the arms & legs, sometimes on both sides of the body.
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What are 3 features of clonic seizures
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1. length is highly variable
2. only occur in rare cases 3. usually NOT followed by period of tiredness or confusion |
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This is one of the most common forms of seizures
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Tonic-clonic seizures
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What happens during a tonic clonic seizure
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First they present with a tonic seizure followed by a clonic seizure
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This type of seizure is referred to as grand mal seizures
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Tonic clonic seizures
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What is the duration of tonic clonic seizure
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Usually 2-3 minutes
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What should be done if a tonic clonic seizure last > 5 minutes
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Call for medical help
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How does tonic clonic seizure affect consciousness
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It is lost and usually slow to return
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T/F: After a tonic-clonic episode, patient is fine & can function normally
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False: patient may feel sleepy, agitated, confused, or depressed
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Define status epilepticus
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Defined as a single instance of a seizure lasting ≥ 30 minutes, or 3 seizures that occur without a normal period in between.
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This is a common grouping of specific signs & symptoms
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Syndrome
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________ are objective findings such as weakness & __________ are subjective findings such as a feeling of fear or tingling in a finger
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Signs, symptoms
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What 7 things define an epilepsy syndrome
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1. The type or types of seizures observed.
2. The age of onset. 3. The cause or causes of seizures. 4. Area of the brain involved. 5. Factors that promote seizures. 6.Severity, frequency, and time of seizures. 7. Characteristic EEG patterns observed during and between seizures. |
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What type of seizures are febrile seizures
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Tonic-clonic
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Who is more likely to get febrile seizures
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Occurs in children between 3 mo & 5 yrs when they have a high fever
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What are 4 features of febrile seizures
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1. occurs in 2-5% of children
2. run in families 3. fever reduction does not prevent seizures. 4. most children do not have seizures without fever after age 5. |
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What is childhood absence epilepsy
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Characterized by simple absence seizures presenting in children btn 4-8 yo.
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What is a precipitating facture for CAE
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Often it's exercise
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Before CAE develops in children, what other seizure may be observed
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Tonic clonic w/ or w/o fever before CAE develops
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% of patients who have CAE
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2-8%
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Cause of CAE
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Primarily genetic
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This presents as myoclonic seizures in juveniles
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Juvenile myoclonic epilepsy
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What time of day do u see JME
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Observed in the early morning or shortly after awakening.
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This epilepsy is one of the most common forms, accounting for 7% of all cases
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JME
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T/F: JME has a genetic component b/c it's more likely in people with relative who have some form of generalized epilepsy
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True
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What are photosensitive seizures
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Seen in patients with JME which is initiated by strobe lights, TVs, video games, etc
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_______ ________ ________ is a partial epilepsy arising from the temporal lobe of the brain
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Temporal lobe epilepsy
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What is the clinical picture of seizures in TLE
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Widely varied but often include auras of many types
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What other seizures are common with TLE
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Simple partial, complex partial, & secondarily generalized
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Some TLE patients have mild ________ deficits
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Memory
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Age of onset of TLE & precipitating factor
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Develops at any age & sometimes observed following head injury or cerebral infection
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After TLE, this the most common form of epilepsy featuring partial seizures
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Frontal lobe epilepsy (FLE)
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What other seizures are observed w/ FLE
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Both simple and complex partial
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What is the clinical picture of FLE
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A wide range of presentations is seen since the frontal lobes is not completely understood
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Define automatisms
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Inappropriate expression of coordinated mm activity than most other types of seizures
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When do u see automatisms
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If complex partial seizures originate in the frontal lobe, there is a higher incidence of producing this
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How do u get a definitive Dx for FLE
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EEG during the seizure
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What are some causes of symptomatic epilepsies
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1. head trauma
2. drug intoxication 3. cerebral infection 4. stroke 5. brain tumors |
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What is the cause for idiopathic epilepsies
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Unknown but etiology of some has a strong genetic component
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What are the primary goals to protect the patient from injury during a seizure
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1. cushion their head
2. clear space if necessary 3. don't move them unless in dangerous location 4. do not restrain |
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Which seizure is resistant to pharmacotherapy
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atonic
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What is becoming more frequent for the treatment of epilepsy
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Surgery
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What are common targets in the brain for surgical treatment of epilepsy
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Amydgala, anterior hippocampus, & entorhinal cortex
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Partial removal of corpus callosum helps in what
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It can be used to prevent a partial seizure from evolving
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which of these readings would have the biggest amplitude? a. alpha b. beta c. delta d. theta e. c & d
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E. c & d
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T/F: : EEG is a good tool for telling about the exact nature of the synaptic activity but very bad tool for measuring activity across the brain.
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False: it's a bad tool for telling exact naure of the synaptic activity but very good tool for measuring activity across the brain
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what kind of synapses are seen in thalamic & cortical axons?
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in thalamic, more proximal synapses & in cortical, more distal synapses are seen
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All generalized seizures seem to involve all the ________ simultaneously
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leads
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Each neuron in the seizure focus experiences a synchronized response called?
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a paroxysmal depolarizing shift (PDS)
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Describe the PDS
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a large (20-40mV), long lasting (50-200 msec) suprathreshold depolarization
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In EEG, when looking at the PDS, what is the depolarization d/t?
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It's d/t glutamate R opening & voltage gated Ca channels
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In EEG, when looking at the PDS, hyperpolarization is d/t what?
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Activation of GABA receptors.
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The feedback & feed forward circuits are found where in the brain?
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in the hippocampus & cortex
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Cells a and b have a recurrent __________ connection to each other
Cells d and c are inhibited when the feedback _______circuit for cells a or b (respectively) are activated, but they are not part of the recurrent excitatory network. This interneuron will therefore have ________ neuron that goes to a or b & a collateral neuron that goes to c or d. in this simple model, ________ input to either cell a or b will activate both cell a and b, and also create an _______ ________ by inhibiting cells c and d Cells a and b also each have one feedback_________circuit |
excitatory
inhibitory inhibitory collateral ‘Inhibitory Surround’ excitatory |
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All these neurons release what?
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release glutatmate in all the neurons but GABA at the star shaped cell bodies
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so overall the cause of seizures is basically d/t what 2 things?
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increased excitation or decreased inhibition
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what is the fxn of surround inhibition?
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Surround inhibition normally works to contain a seizure focus and thus prevent spread of partial seizures.
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breakdown of surround inhibition leads to an increase in _________ of neuronal activity, and contributes to spread of ________ __________.
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synchronization
partial seizures |
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Incidence of schizophrenia worldwide?
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1-2%
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Age of onset of schizophrenia for males & females?
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Late teens for males & early 20’s for females
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Major risk of schizophrenia for those who don’t get treatment?
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10% suicide
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Define schizotypal personality?
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A few delusions but function is ok overall
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Define schizoaffective disorder?
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some schizo symptoms w/ mood disorder
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What are the genetic risk factors for schizophernia?
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1st degree relative 10% risk,,
both parents schizophrenic 40% risk, dizygptic twins 10% & monozygotic twins 50% |
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What are some gestational &/or birth complications that is a risk factor for schizophrenia?
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Flu, nutrition. The reason this doesn’t show up at the time of the insult is that the prefrontal lobe takes time to develop so that could be a reason why it takes a while to manifest
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What are 4 riks factors for schizophrenia?
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1. Genetics,
2) gestational &/or birth complications, 3) winter birth, 4)early history of ADHD |
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What are the + symptoms of schizophrenia?
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1) hallucinations,
2) delusions, 3) disorganized speech/formal thought disorder 4) disorganized/ bizarre/catationic behavior |
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What are the negative symptoms of schizophrenia?
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1) alogia,
2) affective blunting, 3) anhedonia, 4) avolition/amotivational 5) asocial |
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What are the cognitive defects of schizophrenia?
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1) tangentiality,
2) loss of goals, 3) incoherence, 4) looseness of associations, 5) neologisms |
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If patients has more positive symptoms, they would have more of a what type of schizophrenia?
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Paranoid
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If patient has more negative symptoms, they would have more of what type of schizophrenia?
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Disorganized
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What is the brain pathophysiology in patients with schizophrenia?
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1) slight reductions in neocortical gray matter volume,
2) decreased neuronal size in corticolimbic structures, 3) diffuse ventricular enlargement, 4) reduced dendritic spine density & increased neuronal disarray in neurons of the prefrontal cortex, 5) decreased metabolic activity especially in prefrontal cortex |
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T/F: Hypotheses of causes of schizophrenia are mutually exclusive and not related at all?
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False: the are not mutually exclusive & probably related
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What are the different hypotheses of the cause of schizophrenia?
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1) DA hypothesis where mesolimbic (Nac) DA excess causes positive symptoms & mesocortical (prefrontal) DA deficiency involved in negative symptoms & cognitive defects,
2) glutamate hypothesis where loss of NMDA R , 3) other NT imbalances like 5HT, GABA, & neuropeptides, 4) GF like NGF & BDNF (peptides released in brain to enhance connections) are missing therefore connections are not made |
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With schizophrenia, why is there too much DA in Nac & too little in prefrontal?
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Possible reasons:
1) there aren’t enough to inhibit D2 R & 2) 5HT inhibits prefrontal so perhaps there’s too much 5HT there which leads to little DA released |
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What happens if there is too little DA in the mesocortical system?
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It would shut off the inhibitory pathway between the pre-frontal & Nac therefore more DA would be made in the mesolimbic
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Types of R’s found on the inhibitory pathway between prefrontal & Nac?
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90% D3/D4 & 10% D2
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What is the MOA for the old antipsychotic drugs?
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It was thought that since too much DA is made in mesolimbic, shut it off by Rx-- stops the DA --decreases the positive symptoms but this does not help the mesocortical pathway. This is b/c you’re targeting the D2 R specifically. However by giving drugs that block D2 R, mesocortical DA is going to decrease further & cause worse negative symptoms & also movements will be worse
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What is the mechanism with the new antipsychotic drugs?
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Give 5HT-2A/C antagonist which will take inhibition away from prefrontal (since you’re inhibiting the over active 5HT there), the inhibition between prefrontal and NAc is put back and you also decrease the DA in the mesolimbic and there will be less effect on the striatum so there will be less movement problems.
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What is needed to make a diagnosis of depression?
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At least 5 symptoms must persist for at least 2 weeks
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Be familiar with symptoms of major depression?
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1) depressed mood which is seen as irritability in adolescents,
2) anhedonia or diminished interest or pleasure, 3) significant wt gain or loss, 4) insomnia or hypersomnia, 5) psychomotor agitation or retardation, 6) fatigue or loss of energy, 7) feeling worthlessness or unfounded guilt, 8) indecisive, unable to think or concentrate, 9) recurrent thoughts of death or suicide |
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What are the features for unipolar depression?
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1) 2x more like in F,
2) 1.5-3x greater risk w/ + family Hx but not affected in monozygotic or dizygotic twins, 3) marital status (separated or divorced=higher rates, married males=lower rates, married females=higher rates) 4) an increased risk 6 months postpartum, 5) increased risk w/ negative life events & early parental death |
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Which depression has a higher genetic association?
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Bipolar
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Features of bipolar depression?
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1) 1.5% incidence worldwide
2) 10% primary family, 3) 80% monozygotic 4) same male to female ratio |
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Basic pattern of
1) Atypical, 2) melancholic, 3) dysthymia? |
1) Hypersomnia, overeating,
2) insomnia, anorexia, 3) milder symptoms that last 2 yrs or more |
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Talk about seasonal affective disorder?
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Depression during the winter months d/t disregulation of melatonin
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Talk about premenstrual dysphonic disorder or during post partum?
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May not need to take Rx all of the time but just around the time cycle or having a baby. These drugs have a different MOA where they tend to work faster than the normal drugs that take 4-6 wks
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What are the criteria for manic episode?
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A distinct period of abnormally & persistently elevated or irritable mood w/ at least 3 symptoms
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Drugs for bipolar are targeted towards what?
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Meds try to focus on manic phase b/c it’s more dangerous to the person
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What are the symptoms of manic episode of bipolar disorder?
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1) Inflated self esteem or grandiosity
2) more talkative or pressure to keep talking 3) subjective feelings that thoughts are racing 4) distractibility 5) increased goal directed behavior 6) psychomotor agitation 7) excessive involvement in risky activities 8) mood disturbances sufficiently severe to cause marked impairment in occupational or social functioning or hospitalization to prevent harm to self or others |
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What do most antidepressant drugs do w/ NT?
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Increase 5HT & NE levels
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Suicide victims with major depression have increased what?
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5HT-1A autoR & 5HT-2 postsynaptic R
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_______ can improve depression in selected patients?
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Tryptophan
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What are the hypotheses for NT/R/2nd messenger systems leading to unipolar depression?
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1)decrease in 5HT & NE,
2) increase in 5HT-1A autoR & 5HT-2 postsynaptic R, 3) faulty signal transduction mechanisms, 4) stress inhibits CREB to make GFs & therefore decreases connection between neurons 5) a defect in substance P or neurokinin 1 R |
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Some clinical trial show neurokinin 1 ___________ have antidepressant actions?
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Antagonist
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In the depression hypotheses, what the relationship between stress and depression and thyroid and depression?
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Stress: about ½ of patients with depression exhibit cortisol hyper secretion that abates when mood normalized which means there is a clear link to stress mechanisms. THYROID: depressive symptoms common with hypothyroidism where T3 & TRH administration improves symptoms and efficacy of antidepressant drugs
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What is the effect of antidepressants on stress & hormones of stress?
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Symptoms of stress & therefore levels of CRF began to decrease 6 months or so after beginning to take Rx. In fact those who continued to take Rx even after they began to feel better where their CRF & cortisol began to be normal had a less likely chance of developing a recurrence
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What is the relationship of depression and sleep?
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Those with depression have more REM where it occurs earlier in the cycle & lasts longer (shortened latency to REM & increased REM duration); if someone is deprived of sleep, it may transiently improve their mood
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Increasing dose needed to produce original response?
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Tolerance
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What are the 5 components to tolerance?
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1) Dispositional,
2) functional, 3) learned, 4) cross-tolerance, 5) reverse tolerance |
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This type of tolerance is not responsive selective?
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Dispositional
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Change in body’s response to drug?
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Functional tolerance
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This type of tolerance is responsive selective?
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Functional
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Which part of tolerance might be the basis for dependence?
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Functional
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Change in the drug’s pharmacokinetics?
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dispositional
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This has a lower concentration at the site of action?
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Dispositional
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In ___________ tolerance, the body is metabolizing the drug faster than normal therefore less of the drug is around so to get the same effect, a person has to take more of the drug?
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Dispositional
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Of all the side effects from opioides, which one does not develop tolerance?
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Respiratory depression
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How would a graph look if you are graphing effect vs. drug [ ] as you build tolerance to the drug?
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The curve would be moved to the right since you would need more of the drug to have the same effect.
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In functional tolerance, where is the change for the drug?
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The SOA is changed so the response to the drug is different. You have the same amount of drug but the response to it has changed.
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Environmentally dependent?
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Learned tolerance
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Define cross tolerance & where does this become an issue?
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Different drugs in the same class would have the same tolerance; if a person is an alcoholic he would be tolerant to alcohol and also to barbiturates therefore this is asked before surgery d/t anesthetic barbiturates.
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This is the opposite of tolerance?
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Reverse tolerance or sensitization
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For this, drug must be taken to prevent withdrawal?
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Physical dependence
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This is usually opposite to initial drug effects?
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Abstinence syndrome
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Severity of abstinence syndrome is determined by?
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Pharmacokinetics
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The shorter the half life of a drug the ______ the abstinence?
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Worse
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Give an example of abstinence syndrome?
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Drinking ->decrease GABA R --> stop drinking ---> low GABA R ---> take time for body to rebuild up GABA R
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_______ __________ leads to substance dependence?
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Abuse liability
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What determines abuse liability?
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1) Type of drug agent
2) user 3) environment |
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3 features that affect the type of drug agent involved in abuse liability?
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1) Reinforcing effects where there is an increase in DA in NAc (any drug w/ high abuse liability will have high DA)
2) pharmacokinetic variables such as route, onset, and duration have an effect on abuse liability 3) cost & availability |
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2 things that may affect whether a user will have abuse liability or not?
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1) Genetics since different genes control sensitivity, tolerance, dependence, addiction & each individual is different in these factors
2) behavioral where there has been a possible past use, personality, and even other psychiatric symptoms |
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What brings on craving of a drug?
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Prolonged withdrawal syndrome where the person has not completely recovered from the drug
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These 2 things relate to the environment in how it affects abuse liability?
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Societal norms & stressors
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Give an ex how 2 reasons why someone may have a relapse from a past drug?
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A previous alcoholic can relapse back by drug induced where he takes one sip & can’t stop and also by environmentally induced where he’s in the same place and the same people he used to drink with so past used and learned tolerance will kick in and will have a craving.
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__________ can have direct effect on mesolimbic pathway and therefore stimulate a relapse for addiction?
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Cortisol
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What is the mechanism of how opioids, nicotine, and amphetamine work in increasing DA & creating a craving?
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Nicotine binds to Nic Ach and increase DA in the mesolimbic & mesocortical pathways. Opioids bind to mu R which shut off GABA (an inhibitory NT against DA) which increases DA. Amphetamine works at NAc to block DA transporter or reverse it and increase DA
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